Ulcers and timeline for improvement?

[Critter]

Okay…so the original saga was on this post: Sudden onset of resistance in 4yo - Update #37

For those who want the cliff notes…my 4yo had been going great until suddenly he was not. Balking, pawing, backing up under saddle. Definitely seemed pain related, not naughty baby horse. Full work-up early June at the university clinic. They did find mild ataxia and some questionable stuff at the neck. On my request they also scoped and found grade 3 squamous ulcers. He had already been on 1/2 tube UG for a month (because he was getting spooky).

So, he has been 2-3 weeks on 3x day sucralfate. We started a week ago 1 full tube/day ulcergrad (per vet instructions). He was allowed to go back to light walking on a loose rein this week. General behavior on the ground is so much better - much more chill and happy horse.

Yesterday, I get on…and it’s pretty ugly with the balking and not going forwards. But he didn’t feel explosive and after 10 minutes he started to walk a few laps. Cool…figure we got through the this used to hurt behavior and now is better. Still felt like it took a lot more to get to that point than it should have.

Today, I tried a different saddle that seems to fit better…noticed that when I was comparing saddles he was grumping at me, which he never used to do. In my mind, if there was a saddle component and he’s better today, then it might just be he’s better or maybe he’s more comfy in this saddle. WRONG.

OMG I didn’t think I was going to be able to dismount in time before I got launched.

Took him in the ring, he was super chill…as in sleeping on the lunge. Thought, yay, this is so much better. Get on and he humps up his back big time (never did this before)…i just give him a minute and then ask to walk off. He takes 3 steps forwards, humps up and starts to get super upset. I admit I got off super quick…it was pretty clear I was about to come off anyway, and I prefer to do it on my own terms! LOL I actually then took the saddle off and laid over him bareback at the mounting block and he started aggressively pawing (which is the behavior that took us to the vet clinic in the first place).

So…it could very well be the ulcers are not yet healing enough. Could be there are also hindgut ulcers (picking up some pH test strips tomorrow). I don’t think he’s being a brat (maybe a tiny bit, but really, he’s just not that type). He is definitely angrier with the saddle on (multiple saddles tried - doesn’t matter).

I did notice him laying down a bit more outside this week (we had gone to 2x day sucralfate as per vet when we started the ulcergard)…I’ve bumped him back to 3x today. From a management perspective (ie low volume grain/ration balancer, lots of grass turnout night/part day until buggy, free choice hay and alfalfa cubes) he should not have ulcers. This all did start after a fever if unknown origin (treated for tick borne illness, but tests negative still).

Going to let him chill until we can rescope…not worth reinforcing this behavior either. But I would have though some improvement by now? I mean, it could also be neck (he is scheduled for a myelogram later this summer, but I wanted to see if it was just ulcers first). But even if it is neck, I would think he wouldn’t be that angry with just sitting on him with the contact on the buckle? There was zero issues on the back xrays too, so no kissing spines.

I wish he could just talk more clearly to tell me what it is.

[candyappy]

That is a disappointing update. I don’t doubt the ulcers but I wonder if despite trying several saddles that saddle fit is still part of the puzzle?

[Critter]

My next thought is to borrow a Western saddle from a friend…since that was what he was started under saddle with and ridden in most of the time. Going to give him a bit more time off since I am traveling anyway next week…but definitely considering a trial with a Western. I have access to 5 different dressage saddles I can try on him…two seemed to sit well on his back…the other 3 definitely were not a fit at all.

[NancyM]

Removing the source of his stress that is causing the ulcer is just as important as medicating it. Medication without removal of the stressor won’t get you far. Do you have some guesses as to what the stressor may have been? Or is currently? Have you made some changes in his lifestyle and training? Only you can dissect his life and lifestyle to find out what it might be, can be something that other horses accept no problem. Can be something simple, or something that no one else can imagine. Good luck.

[GraceLikeRain]

@Critter

But I would have though some improvement by now?

Grade 3 squamous ulcer are pretty darn bad. When mine scoped with those I was asked to not even think about sitting on her until she scoped clear. Did your vet recommend ulcergard over gastrogard? I’d be curious to know why they would recommend backing down the sucralfate so early in treatment.

Are you giving the UG on an empty stomach but otherwise keeping forage in front of him 24/7?

At 3 weeks into treatment I would not expect to see a transformation. Some here have but I don’t know if that is the norm.

[Critter]

Thanks for that info…I had one horse, years ago, with a really bad case of ulcers…he was riding fine but had just become super spooky, so that’s my only comparison for behavior (in that case, we found the ulcers as he started to lay down like a colic and the vet clinic was quick enough on the differential dx). So, my young guy’s behavior presentation is quite different than what I’ve dealt with before with ulcers (except the being spooky part).

The vet clinic is the one who suggested I go back to walking loose rein this week. I’ve now decided to hold off until we rescope. They were also the ones who said either 2-3 x a day for the sucralfate…so I did the 3x to start, and then dropped to 2x when I added in the UG. Now we are back to 3x.

UG and GG are the same drugs…we are doing a full tube of UG, so it’s no different than giving the full tube of GG. Trying to do it on as empty a stomach as possible, given that he’s mostly turned out…and has free choice hay when he’s in for the heat/buggy part of the day. He’s out on grass all night and through midday, and just comes in when the bugs are bad.

I have definitely seen a transformation on the ground (back to his normal personality)…it just hadn’t carried over to under tack yet.

As for stressors…he’s got it pretty good right now. We really do think the trigger was the laceration/stall rest/meds at the trainers…followed by a 14 hr trailer ride home a few weeks after that…then a fever/more meds episode (not related to shipping - was 2 months after getting home). So my guess is that all started it, and now we are playing catch up to heal it all.

[Amy3996]

3 weeks is almost nothing in the scheme of ulcer healing. It takes several days (even up to 2 weeks according to one of the vets that treated my horse) for GG/UG to reach peak effectiveness. Squamous ulcers are also tough little buggers to really get rid of.

I think your plan to let him be turned out until the rescope is a good one. Whether it’s ulcer pain or a different issue, his behavior at the mounting block and under saddle is warning you that something is still not right.

[4horses]

I’m in a similar boat with my free horse. She rides fine, but doesn’t eat well. I’ve been mixing soaked alfalfa+grain+ canola oil. She eats… It just takes a couple hours for her to finish and the hay sits there. She does nibble on hay but does not eat like she should. She grazes voraciously… But I don’t have much pasture. Prior owner just fed alfalfa pellets and concentrate twice daily. Nothing to eat in between. She’s had her teeth done recently.

Hoping her appetite picks up. I always worry when they don’t eat well.

[IPEsq]

I had a horse who would do that when he had ulcers. He also was a baby and we had saddle fit issues but it would be more extreme like that because of ulcers. Although he was a little more kind and just threatened to scrape me off on the fence with a hump in his back before escalating. This was also my horse with neck issues and the balking behavior remained after ulcers were treated before we treated the neck.

Since it’s only been 1 week on a full dose of Gastrogard, I am not surprised. For more mild ulcers I’d say at least 2 weeks. Grade 3 is pretty bad and could take longer than the usual month course to treat so 2 weeks might also be too soon.

If he’s quiet to longe, then I’d do that periodically but not try to ride for at least another week, maybe until after the re-scope.

I can’t recall if you injected the neck also. Steroid injections can exacerbate tummy stuff (at least that was the case for my horse) and it could also be a month before you know if those injections are going to really help.

[Critter]

We did inject the neck and he was on gabapentin 2x day for the first two weeks, now weaning that down.

I can lunge him - now that he is back to normal on the ground behavior, he’s super easy and quiet for that (which makes the under saddle behavior all the more extreme!). He’s really an easy going baby horse, so that’s why I know this has to be pain/medical. Right now, I’m just going to hand walk, groom, do groundwork and loading, etc. Nothing too high pressure.

I also did the pH test on his manure tonight…it reads at 6.0 which is way more acidic than it should be. So, I just ordered the extra large bottle of compounded sucralfate from Farm Vet as I have a feeling we will be on that for quite some time.

[IPEsq]

How many grams of Sucralfate is he getting per dose?

[Critter]

12g three times a day

[IPEsq]

That should be helping. I’d give the full dose of UG/GG more time. I think you can get results giving Gastrogard without them being on an empty stomach. More important to space it out away from the Sucralfate doses.

[Critter]

I think going back to the 3x day sucralfate is better…when I dropped him to 2x a week ago, he was laying down outside more. He seemed much more relaxed today after going back up to 3x day. Manure is better too.